title: Real-time visualization of ultrasound-guided retrobulbar blockade: an imaging study.
abstract: BACKGROUND
  Retrobulbar anaesthesia allows eye surgery in awake patients. Severe complications of the blind techniques are reported. Ultrasound-guided needle introduction and direct visualization of the spread of local anaesthetic may improve quality and safety of retrobulbar anaesthesia. Therefore, we developed a new ultrasound-guided technique using human cadavers.
  
  
  METHODS
  In total, 20 blocks on both sides in 10 embalmed human cadavers were performed. Using a small curved array transducer and a long-axis approach, a 22 G short bevel needle was introduced under ultrasound guidance lateral and caudal of the eyeball until the needle tip was seen 2 mm away from the optic nerve. At this point, 2 ml of contrast dye as a substitute for local anaesthetic was injected. Immediately after the injection, the spread of the contrast dye was documented by means of CT scans performed in each cadaver.
  
  
  RESULTS
  The CT scans showed the distribution of the contrast dye in the muscle cone and behind the posterior sclera in all but one case. No contrast dye was found inside the optic nerve or inside the eyeball. In one case, there could be an additional trace of contrast dye behind the orbita.
  
  
  CONCLUSIONS
  Our new ultrasound-guided technique has the potential to improve safety and efficacy of the procedure by direct visualization of the needle placement and the distribution of the injected fluid. Furthermore, the precise injection near the optic nerve could lead to a reduction of the amount of the local anaesthetic needed with fewer related complications.
authors.affiliation: Department of Anaesthesiology and Pain Therapy, Bern University Hospital and University of Bern, Inselspital, CH-3010 Bern, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Luyet
authors.forename: U
authors.initials: U
authors.lastname: Eichenberger
authors.forename: B
authors.initials: B
authors.lastname: Moriggl
authors.forename: L
authors.initials: L
authors.lastname: Remonda
authors.forename: R
authors.initials: R
authors.lastname: Greif
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000493:pharmacokinetics; D005123:Eye / Q000000981:diagnostic imaging*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D009900:Optic Nerve / Q000000981:diagnostic imaging; D009915:Orbit / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D003287:Contrast Media